An audit of the workload of an acute surgery unit in a tertiary academic hospital before and after the closure of a referring community hospital

Abstract

Aim: An audit of the workload of an Acute Care Surgery Unit in a Tertiary Academic Hospital and an assessment of the impact on this Unit by the closure of a busy Community Hospital. Background: The primary mission of the Acute Care Surgery service is to provide timely surgical assessment, operative and/or non-operative management of the acutely ill non-trauma surgical patient. Both locally and internationally, fewer surgeons are perusing general practice, opting instead for subspecialty training, with no or only minimal time spent in emergency surgical care. This is demonstrated for example by evidence that some colorectal surgeons refer diseases of the appendix to the general surgeon, reflecting the narrow point of care that is being practiced in certain fields of surgery. In many cases acute care surgery has been described as a multidisciplinary approach involving Emergency and Trauma Surgery, and Critical Care Medicine.(1-3) In South Africa the rules and regulation by the Health Professions Council stipulates the requirement of training and qualifying as a General Surgeon, before pursuing Fellowship training in a field of subspeciality. As treatment paradigms shift and surgical emergency disease management evolves, we need properly trained surgeons that are willing to pursue the optimal emergency care (surgical or non-operative) for specific conditions in patients presenting with these acute surgical emergencies.(2,4) Groote Schuur Hospital (GSH) is privileged in its provision of an Acute Care Surgical Unit (ACSU) that functions in a tertiary environment and is affiliated with the University of Cape Town (UCT), the leading ranked University on the African Continent. The ACSU in GSH has 28 dedicated beds, and functions as a secondary and tertiary level General Surgery Unit excluding all acute trauma care. Provision is also made for the management of primary level surgical diseases. A neighboring surgical referral hospital, GF Jooste Hospital (GFJH), has 90 dedicated surgery beds. It is a Community Hospital, which caters for primary and secondary level diseases. Acute care is also given to tertiary level trauma and emergency surgical diseases. The unit at GFJH will be closing to allow for a reconstruction of the building, and thus the patient population will require access to alternate facilities whilst awaiting the reopening. A subset of these patient will have to be accommodated at GSH.